Background The COVID-19 pandemic resulted in increased demand for specialist palliative care, however, there is little description in the literature of the impact on specialist community services (Bone, Finucane, Leniz, et al., 2020). Service-level changes were made by an inner London hospice and community team to respond to changing needs and pressures on local acute hospitals and primary care.
Aims To explore how the COVID-19 pandemic impacted local hospice referrals made and describe how inpatient and community services adapted across the first and second waves.
Methods A retrospective analysis of referral data was conducted, comparing first and second COVID-19 waves (5 March 2020 - 31 May 2020 and 5 November 2020 - 23 February 2021 respectively) with ‘control’ data for the same periods, one year prior. Qualitative methods were used to describe new interventions and adaptations to the delivery of care across the service during this period.
Results There was little change in referrals for hospice services, when comparing control waves with COVID-19 waves. Several adaptations were made which ensured that safe delivery of care could continue across all settings including early fit-testing for staff, vaccinations, regular testing and the introduction of inpatient COVID-19 referral pathways. Referrals for COVID-19 positive patients to the inpatient unit increased between the first and second waves. Despite improved attendance at virtual care home MDTs, fewer referrals were received compared with the control waves.
Conclusion Though overall referrals to the service did not change when compared with control waves, the number of referred COVID-19 patients increased between first and second waves. This may reflect adaptations in and improved use of dedicated COVID-19 pathways by acute hospitals. The reduction in number of care home referrals may represent lost referrals due to a preference for remote advice over face-to-face reviews and deterioration of residents before referral could be made.
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